Billing Worklists

 

This function can be used to generate a list of patients who have unapplied credit or prepayment balances. You can use this worklist to identify patients with unapplied credit and/or prepayment balances that should be applied to outstanding charges.

Tip: To display the list of patients who have balances in their prepayment plans and also have outstanding patient balances, use the Prepayments Worklist.

 

Note: You must have the Credit Balance Worklist permission to generate the worklist.

1. Display the Billing Worklists page: On the Main Menu, click Claims. Under CLAIM MANAGEMENT, click Billing Worklists.
2. At the top of the page, in the View Patients with Credit Balances section, use the menus and fields provided to generate a worklist with the desired contents.

With athenaEnterprise

To filter the results based on provider group, select the provider groups using the Show All Accounts in the Provider Group menu.

 

The worklist shows patient accounts grouped by their primary patient department. Depending on the criteria that you selected, the worklist will contain some or all of the following:

• Patient Last Name, Patient First Name, Patient ID# (which links to the patient's Quickview)
• The total outstanding patient amount on the account
• The amount in Unapplied (this does not include any money associated with prepayment plans)
• The amount in each prepayment plan for the patient
• Post Payment (a link to the Post Payment page)

 

This search is useful for tracking down errors in a payment batch.

1. Display the Billing Worklists page: On the Main Menu, click Claims. Under CLAIM MANAGEMENT, click Billing Worklists.
2. In the Search for Payments by Check Number section, enter either the full or partial check number.
3. In the Payment Method field, click Check.
4. Click Search for EXACT Number or Search for SIMILAR Number.

The "similar" search results include check numbers that begin with leading zeros, as well as those that begin with the number you entered. For example, if you execute a "similar" search for check number 123, the search results include check numbers such as 00123 and 0123, as well as numbers such as 1230 and 12345. If you execute a "similar" search for check number 000123, the search results include check numbers such as 1230 and 1234, as well as 000123 and 1234.

 

The worklist displays:

• The claim's date of service
• The patient's name and ID (hover over the patient's name to display additional information)
• The payment amount
• The check number of the payment
• The patient's insurer

You can click the patient name to access the patient Quickview page.

 

 

This search is useful for tracking down electronic payments.

1. Display the Billing Worklists page: On the Main Menu, click Claims. Under CLAIM MANAGEMENT, click Billing Worklists.
2. In the Search for Payments by Check Number section, enter the full or partial check number.
3. In the Payment Method field, click ACH.
4. Click Search for EXACT Number or Search for SIMILAR Number.

The "similar" search results include check numbers that begin with leading zeros, as well as those that begin with the number you entered. For example, if you execute a "similar" search for check number 123, the search results include check numbers such as 00123 and 0123, as well as numbers such as 1230 and 12345. If you execute a "similar" search for check number 000123, the search results include check numbers such as 1230 and 1234, as well as 000123 and 1234.

 

The worklist displays:

• The claim's date of service
• The patient's name and ID (hover the cursor over the patient's name to display additional information)
• The payment amount
• The check number of the payment
• The patient's insurer

You can click the patient name to access the patient Quickview page.

 

 

This worklist identifies claims in OVERPAID status.

1. Display the Billing Worklists page: On the Main Menu, click Claims. Under CLAIM MANAGEMENT, click Billing Worklists.
2. You can click Show Overpaid Claims to generate a list of all patients with claims that have been overpaid as a whole (as opposed to claims that contain individual charges that were overpaid).
   
   Tip: From the View Claims Worklists page, you can select the OVERPAID; By Payor option to view all claims that have one or more individual charges that are overpaid. The worklist results also include claims that have been overpaid as a whole.
   • You can filter the list by service department, and you can click the patient name to access the Issue Insurance Refund page.
   • athenaEnterprise clients can filter the results based on provider group: select the provider groups using the Show All Claims with the Provider Group menu.

The worklist also allows you to reconcile against takebacks. The worklist displays:

• The claim's date of service
• The patient's name and ID
• The claim's outstanding amount
• The insurer
• The last claim error

Automated overpayment resolution

Beginning in November 2017, athenahealth intercepts and reviews overpaid claims in HOLD, MGRHOLD, or OVERPAID status sent with any of these kick codes:

• OVERPYMT
• OVERPY1MRY
• OVERPY2NDY
• OVERPYEOBPOST

After reviewing the claim, we either:

• Resolve the overpayment issue on the claim.
• Provide next steps for how you or the payer can resolve the overpayment (we may contact the payer on your behalf to determine the next steps).

When athenahealth is working a claim for overpayment, the kick code OVERPYMTATHENACALLPAYER or OVERPYMTATHENARVW appears in the claim notes within 3 days. These kick codes move the claim to CBOHOLD status.

Note: athenahealth does not resolve overpaid claims with service restrictions that you may have applied or overpaid claims that were already in your worklists prior to your practice's rollout date for this service.

 

athenahealth may need to send a claim back to you under these circumstances:

• We cannot reach the payer.
• The payer cannot or will not provide us with the necessary information.
• The claim must be voided from the payer's portal.
• You must coordinate benefits with the patient or the patient must do so with the payer.
• A refund check is required to resolve the overpayment with the payer.
• A determination from you is required to accept an overpaid balance.
• You changed something on the claim that caused the overpayment.

 

 

The overpaid claims worklist should be reviewed weekly in conjunction with Approve Insurance Refunds. This review will identify all claims that are currently overpaid. Your practice may choose to move claims requiring a refund to MGRHOLD using the kick code "refund." This move will also place claims on the Approve Insurance Refunds worklist.

 

 

Beginning in November 2017, athenahealth intercepts and reviews overpaid claims in HOLD, MGRHOLD, or OVERPAID status sent with any of these kick codes:

• OVERPYMT
• OVERPY1MRY
• OVERPY2NDY
• OVERPYEOBPOST

After reviewing the claim, we either:

• Resolve the overpayment issue on the claim.
• Provide next steps for how you or the payer can resolve the overpayment (we may contact the payer on your behalf to determine the next steps).

When athenahealth is working a claim for overpayment, the kick code OVERPYMTATHENACALLPAYER or OVERPYMTATHENARVW appears in the claim notes within 3 days. These kick codes move the claim to CBOHOLD status.

Note: athenahealth does not resolve overpaid claims with service restrictions that you may have applied or overpaid claims that were already in your worklists prior to your practice's rollout date for this service.

 

athenahealth may need to send a claim back to you under these circumstances:

• We cannot reach the payer.
• The payer cannot or will not provide us with the necessary information.
• The claim must be voided from the payer's portal.
• You must coordinate benefits with the patient or the patient must do so with the payer.
• A refund check is required to resolve the overpayment with the payer.
• A determination from you is required to accept an overpaid balance.
• You changed something on the claim that caused the overpayment.

 

 

You are responsible for working claims with insurance credit balances (overpayments) that appear in OVERPAID status. This work includes contacting the payer, reviewing EOBs, and initiating takebacks or refunds. athenahealth applies the following kick codes when an overpaid claim requires action from you.

Kick Code	Status	Action
ACCEPTOVERPYMT	MGRHOLD	You can keep the remaining payment due to payer or allowable verification.
CLAIMCHANGEAFTERBILL	OVERPAID	You changed information on the claim after the claim was billed. You need to review and confirm the information you changed on the claim, and refund the overpayment because it was made based on the original claim. If necessary, re-bill the claim with the updates.
OVERPAYCOB	OVERPAID	You need to review the coordination of benefits (COB).
OVERPYMTPRACRVW	MGRHOLD	You need to take an additional action, as described in the claim notes.
PORTALTAKEBACK	OVERPAID	You need to go to the payer Web portal and void the charge.
SENDREFUND	MGRHOLD	You need to refund the overpayment.
SENDREFUNDINTEREST	MGRHOLD	You need to refund the overpayment with interest.
UNVERIFIABLEBALPRAC	MGRHOLD	You posted the payment without remittance attached. You need to review the claim to see if you should void the payment or issue a refund.